Note: SGO Issues is currently on hiatus during the COVID-19 crisis, but will resume in summer.
SGO Issues March 19, 2020
SGO COVID-19 listserv available
Useful links for cancer care teams related to COVID-19
Annual Meeting update: Spring webinar series planned
Medicare expands telehealth benefit through end of COVID-19 public health emergency
Coding Corner: Telemedicine billing | David O. Holtz, MD
Online interview tips for fellows and residents
AAGL hosts webinar on COVID-19 preparedness on March 20
Stimulus bills contain help for small businesses
Urge your Senator to support $35 million for Ovarian Cancer Research
Updated 2020 Genetics Toolkit released
SGO has created a listserv for members to share resources, information and practices for treating cancer patients during the COVID-19 pandemic. Join the COVID-19 listserv here. Trouble logging in? Contact firstname.lastname@example.org. Tell your institution/email software to allow emails from @memberfuse.com.
As medical societies and health care institutions develop best practices to manage cancer care during the novel coronavirus (COVID-19) pandemic, SGO will continue to inform members about treatment protocols related to the subspecialty of cancer care and gynecologic oncology. The following links provide guidance related to the impact of COVID-19 on cancer care:
- Joint Statement: Scheduling Elective Surgeries from the Society of Gynecologic Oncology (SGO), American College of Obstetricians and Gynecologists (ACOG), American Society for Reproductive Medicine (ASRM), Society of Family Planning, Society of Gynecologic Surgeons (SGS), Society for Maternal-Fetal Medicine, American Association of Gynecologic Laparoscopists (AAGL) and the American Urogynecologic Society (AUGS)
- How to Manage Cancer Care during COVID-19 Pandemic from the Journal of the National Comprehensive Cancer Network
- COVID-19: What AACI Cancer Centers Are Doing to Mitigate Risks from the Association of American Cancer Institutes
- FDA Guidance on Conduct of Clinical Trials of Medical Products during COVID-19 Pandemic from the U.S. Food and Drug Administration
- Coming soon—SGO-Elsevier Podcast on COVID-19: SGO and Elsevier, the publisher of Gynecologic Oncology, are planning to release a podcast featuring an interview by SGO President Warner K. Huh, MD, with Heidi Gray, MD and Elizabeth Swisher, MD. Drs. Gray and Swisher are both at the University of Washington in Seattle, the first U.S. city to experience an outbreak of the novel coronavirus (COVID-19).
SGO members who come across additional links that they wish to share with their fellow health care practitioners can send their suggestions to Robyn Kurth, SGO Senior Communications Manager at email@example.com.
SGO is planning a series of six one-hour webinars this spring to deliver the most impactful science planned for the SGO 2020 Annual Meeting on Women’s Cancer. Abstracts will be released at noon Central time on the date of each webinar. All other abstracts remain embargoed. Additional science, education and posters are being organized for a possible in-person event later in 2020. MEETING UPDATE FAQS are being updated regularly.
On March 17, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare would expand telehealth coverage to enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning with claims for services on March 6, 2020, Medicare will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.
Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.A range of healthcare providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to Medicare beneficiaries.
Beneficiaries will be able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. Medicare coinsurance and deductible still apply for these services. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
The telehealth waiver will be effective until the COVID-19 Public Health Emergency declared by the Secretary of HHS on January 31, 2020 ends. To learn more, please read the CMS fact sheet and frequently asked questions about this expansion of the telehealth benefit.
The unprecedented impact of the COVID-19 situation has resulted in the need for clinicians to offer telemedicine services if established patients are unable to present to offices for appointments. CMS has established three (3) services/CPT codes below to capture and bill for these services. Please note these codes are to be used only for established patients, and there are specific requirements to bill these services that are provided immediately below the code descriptions.
To bill a telemedicine visit the following criteria must be met:
• Telehealth visit cannot be related to a medical visit within the previous 7 days
• Telehealth visit cannot be billed if an in person visit is going to happen within 24 hours
• Patient must verbally consent and the consent must be documented in the medical record
• Time spent speaking to the patient must be documented in the provider’s note
• Patient is aware co-insurance and deductibles will apply
• Billable for established patients only
• Billable only by MD, DO, CRNP or PA
At my institution, we have been asked to use the following prescription prior to any telemedicine visit to avoid confusion by the patient if they are charged by their insurance companies after the fact:
You and I are about to have a telemedicine check-in or visit. This is allowed because you are already my patient, and you have requested it. This telemedicine visit will be billed to your health insurance or you, if you are self-insured. You understand you will be responsible for any copayments or coinsurances that apply to your telemedicine visit. Before starting our telemedicine visit, I am required to get your consent for this virtual check-in or visit by telemedicine. Do you consent?
|99441||Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion||0.25|
|99442||Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion||0.50|
|99443||Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion||0.75|
David O. Holtz, MD, is a gynecologic oncologist with Lankenau Hospital in Wynnewood, PA.
After the World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic last week, many universities and medical centers have restricted work-related travel for faculty and discouraged non-work-related travel as well. In their online article about video interviews for gynecologic oncology fellows and residents, Ryan J Spencer, MD, MS, from the University of Wisconsin in Madison, WI, and Shitanshu Uppal, MBBS, from the University of Michigan in Ann Arbor, MI, detail options for video platforms, how to prepare for an online interview and tips for scheduling video interviews.
According to the authors, “Given the very real possibility that video interviews will be necessary for the upcoming fellowship and even residency recruitment seasons, there are numerous options and best practices that can be summarized in order to maximize the experience for both the programs and the applicants.”
The article lists several considerations for gyn onc programs when considering video interviews for residency/fellowship spots:
- Programs should select a video interview platform early after consulting with their institution’s Information Technology (IT) specialists.
- They should communicate with the interviewees with detailed instructions on how to install the necessary software prior to the interview day.
- If the program/university has a preferred vendor, the program director and the other members of the team should do test runs and make themselves comfortable with using and troubleshooting the software.
In addition, programs should consider a phone interview back up with clear instructions on how and when to initiate the phone call if issues arise with the video platform.
The American Association of Gynecologic Laparoscopists (AAGL) and their global partners are hosting a live webinar: COVID-19 Preparedness Webinar: Learning from Colleagues and Friends on the Front Lines. Each panel member will discuss their experiences and areas of expertise regarding COVID-19 in their hospital/community, medical advice, and what successful steps have been taken during this pandemic. The 90-minute, live webcast is scheduled for Friday, March 20, 2020 at 1:30 p.m. ET/12:30 p.m. CT, and will be moderated by Jubilee Brown, MD, Levine Cancer Institute, Atrium Health, Charlotte, NC and Linda D. Bradley, MD, Cleveland Clinic, Cleveland, OH. Register today.
Confirmed faculty include the following presenters:
- Jinghe Lang, MD, Peking Union Medical College Hospital, Beijing
- Xiaoming Gong, MD, Woyi Ob/Gyn Medical Group, Beijing
- Xiaoming Guan, MD, PhD, Baylor College of Medicine, Houston, TX
- Lan Zhu, MD, Peking Union Medical College Hospital, Beijing
- Emilie Faller, MD, Hôpital de Hautepierre, Strasbourg
- Geoffroy Canlorbe, MD, PhD, Hôpital Pitié Salpétriére, Paris
- Marcello Ceccaroni, MD, PhD, Sacro Cuore Don Calabria Hospital, Verona
- Joong Sub Choi, MD, Hanyang University College of Medicine, Seoul
- Pere Barri, MD, Dexeus Mujer, Barcelona
- Barbara Goff, MD, University of Washington Medicine, Seattle, WA
- Catherine L. Passaretti, MD, Atrium Health, Charlotte, NC
- Derek Raghavan, MD, PhD, Levine Cancer Institute, Atrium Health, Charlotte, NC
The Small Business Administration is now offering a loan program for businesses impacted by COVID-19. The loans can be up to $2 million at 2.75% and can be used for operating expenses, such as payroll. You may wish to reach out to your Governor’s office for assistance. More information is available at the U.S. Small Business Administration website.
Please join your SGO colleagues in urging Congress to maintain the $35 million in Fiscal Year 2021 for the Ovarian Cancer Research Program (OCRP) at the Department of Defense that SGO secured in last year’s final spending bill for Fiscal Year 2020. SGO’s champions in the U.S. Senate are circulating a Dear Colleague Letter to Members of the Senate urging them to sign a letter to Senate appropriators in support of funding the OCRP at $35 million in Fiscal Year 2021. They have asked for SGO’s help in getting Senators to sign on to the letter to demonstrate broad bipartisan support for OCRP funding. This is especially important given the challenges of social distancing and other restrictions due to COVID-19. Go to SGO’s Washington Alert webpage to send a prewritten email message to your Senator asking them to contact the office of Senator Robert Menendez (D-NJ) to sign on to the letter in support of the $35 million funding level for the OCRP in Fiscal Year 2021. Time is of the essence as the deadline to sign on the letter is the March 31, so please send your email today. For questions about this issue or SGO advocacy activities, please contact firstname.lastname@example.org.
The Society of Gynecologic Oncology, in partnership with the American College of Obstetricians and Gynecologists (ACOG), the National Society of Genetic Counselors, Bright Pink and Facing Our Risk of Cancer Empowered (FORCE) has released the 2020 Genetics Toolkit, updating the case-based content from the original version released in 2016. “The biggest updates involve incorporating the growing use of panel testing for hereditary cancer risk,” said SGO Communications Committee Vice Chair Kristin Zorn, MD. “We’ve also updated the references so that users can access more recent publications easily.”
The Genetics Toolkit is designed to provide critical, practical information to health care providers interested in gaining a deeper understanding of the role of genetics in gynecologic cancers. While not written for a lay audience, patients and families will gain an appreciation for the complexity of genetic testing and the challenges providers face every day.
“We continued with the case format so that the content can be broken down easily for discussion groups with staff, medical students, residents, and fellows,” explained Dr. Zorn.
The toolkit is comprised of specific case studies telling an individual woman’s story. Key points are illuminated from each organization’s perspective. Each case history provides references, national guidelines and society statements. The cases are available as individual PDFs as well as the full toolkit on the Genetics Toolkit page of the SGO website.
Although this Genetics Toolkit is meant for health care practitioners, Dr. Zorn added that physicians can direct their patients to other resources for more information about genetic mutations that may cause gynecologic cancers.
“Our collaborators on the toolkit have excellent resources for the lay public on their websites,” said Dr. Zorn. “The National Comprehensive Cancer Network (NCCN) also has guidelines for patients focused on specific disease sites, including genetic testing when appropriate.”